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AbstractObjectiveThis review aimed to identify health impacts of climate change on persons with disabilities in developing countries as well as factors influencing the vulnerability and resilience of affected individuals to related natural disasters.MethodsPubMed, PsycINFO, Scopus, and Embase databases were searched, 2005 to 2023 inclusive, focusing on the keyword terms “persons with disabilities”, “climate change” and “developing countries”. Identified articles were screened for inclusion and qualifying articles received a full-text review. Of 463 articles identified, following removal of six duplicates, 457 articles were screened; 412 were excluded. Of the remaining 45 full-text articles assessed for eligibility, 15 were selected and included in the review with two additional articles from a manual search.ResultsFindings revealed themes including the impact of climate change on the physical and mental health of persons with disabilities in developing countries. The general theme of resilience to natural disasters and specific coping strategies were also elaborated.ConclusionsWhile there is increasing recognition of the psychosocial impacts of climate change-related natural disasters on persons with disabilities, there remain significant gaps in awareness of mental health needs and related service provision. Resolving these gaps is indispensable to achieving equitable climate change-related health outcomes in developing countries.

ABSTRACTObjective:A systematic literature review (SLR) was performed to elucidate the current triage and treatment of an entrapped or mangled extremity in resource scarce environments (RSEs).Methods:A lead researcher followed the search strategy following inclusion and exclusion criteria. A first reviewer (FR) was randomly assigned sources. One of the 2 lead researchers was the second reviewer (SR). Each determined the level of evidence (LOE) and quality of evidence (QE) from each source. Any differing opinions between the FR and SR were discussed between them, and if differing opinions remained, then a third reviewer (the other lead researcher) discussed the article until a consensus was reached. The final opinion of each article was entered for analysis.Results:Fifty-eight (58) articles were entered into the final study. There was 1 study determined to be LOE 1, 29 LOE 2, and 28 LOE 3, with 15 determined to achieve QE 1, 37 QE 2, and 6 QE 3.Conclusion:This SLR showed that there is a lack of studies producing strong evidence to support the triage and treatment of the mangled extremity in RSE. Therefore, a Delphi process is suggested to adapt and modify current civilian and military triage and treatment guidelines to the RSE.

Background/Introduction:While there are accepted triage and treatment guidelines for the entrapped and mangled extremity in civilian and military resource rich environments, there are none for resource-scarce environments.Objectives:A PRISMA systematic literature review was performed to elucidate the current triage and treatment of the entrapped and mangled extremity to understand the factors that contribute to the decision to amputate, or not amputate, and to extract data to develop clinical guidelines.Method/Description:A lead researcher followed the PRISMA systematic literature review search strategy inclusion and exclusion criteria.A first reviewer was randomly assigned sources. One of the two lead researchers was the second reviewer. Each determined the Level of Evidence (LOE) and Quality of Evidence (QE) from each source.Results/Outcomes:Five-hundred ninety-seven (597) records were screened. Fifty-eight (58) articles were entered into the final study. There was one study determined to be LOE-1, 29 LOE-2, and 28 LOE-3 with 15 determined to achieve QE-1, 37 QE-2, and six QE-3.Data extracted included relevant information to develop clinical guidelines to include physiologic parameters, injury patterns or procedures, imaging, rehabilitation, ethics, and the informed consent process.Conclusion:This systematic literature review showed that there is a lack of studies producing strong evidence to support the triage and treatment of an entrapped or mangled extremity in resource-scarce environments. A Delphi method study is suggested to adapt and modify available evidence extracted to create clinical guidelines in the resource-scarce environment.

AbstractLimb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systemsis the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.

AbstractThe provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening.

Exposure of rats and of human subjects to cold was associated with an elevation of the antifibrinolytic activity of blood. Administration of chymotrypsin to rats and rabbits caused a decrease in the antifibrinolytic activity of blood The possible significance of these and earlier observations on the fibrinolysis antifibrinolysis system in blood is discussed.